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The nurse is caring for a patient with amyotrophic lateral sclerosis (ALS) who is hospitalized with pneumonia. Which of the following actions should the nurse take?
- A. Assist with active range of motion
- B. Observe for agitation and paranoia
- C. Give muscle relaxants as needed to reduce spasticity
- D. Use simple words and phrases to explain procedures.
Correct Answer: A
Rationale: ALS causes progressive muscle weakness. Patients should be guided to use moderate-intensity, endurance-type exercises for the trunk and limbs, since this may help reduce ALS spasticity. When hospitalized with other health concerns, it is important to complete ROM to maintain strength. Psychotic symptoms such as agitation and paranoia are not associated with ALS. Cognitive function is not affected by ALS, and the patient's ability to understand procedures will not be impaired. Muscle relaxants will further increase muscle weakness and depress respirations.
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The nurse is teaching a patient with Parkinson's disease preventive measures to reduce the risk of a fall. Which of the following instructions should the nurse include in the teaching session?
- A. Point the toes downward when stepping.
- B. Take two steps backward and three steps forward.
- C. Rock from front to back when walking.
- D. Drop rice kernels and step over them.
Correct Answer: D
Rationale: Patients who are at risk for falling and tend to freeze while walking are at risk of falling. Have the patient learn to drop rice kernels and focus on stepping over them to help prevent falls. Other measures include: pointing the toes upward, take one step backwards and two steps forward, and, rock from side to side, rather than from front to back.
The nurse is caring for a patient with Parkinson's disease who is admitted to the hospital for treatment of an acute infection. Which of the following nursing interventions will be included in the plan of care? (Select all that apply.)
- A. Use an elevated toilet seat.
- B. Cut patient's food into small pieces.
- C. Provide high protein foods at each meal.
- D. Place an arm chair at the patient's bedside.
- E. Observe for sudden exacerbation of symptoms.
Correct Answer: A,B,D
Rationale: Since the patient with Parkinson's has difficulty chewing, food should be cut into small pieces. An armchair should be used when the patient is seated so that the patient can use the arms to assist with getting up from the chair. An elevated toilet seat will facilitate getting on and off the toilet. High protein foods will decrease the effectiveness of L-dopa. Parkinson's is a steadily progressive disease without acute exacerbations.
Which of the following information about a patient who is being treated with carbidopa/levodopa for Parkinson's disease is most important for the nurse to report to the health care provider?
- A. Shuffling gait
- B. Tremor at rest
- C. Cogwheel rigidity of limbs
- D. Uncontrolled head movement
Correct Answer: D
Rationale: Dyskinesia is an adverse effect of the carbidopa/levodopa, indicating a need for a change in medication or decrease in dose. The other findings are typical with Parkinson's disease.
A patient has a new prescription for bromocriptine mesylate to control symptoms of Parkinson's disease. Which of the following information obtained by the nurse may indicate a need for a decrease in the dose?
- A. The patient has a persistent dry cough.
- B. The patient has four loose stools in a day.
- C. The patient develops a deep vein thrombosis.
- D. The patient's blood pressure is 90/46 mm Hg.
Correct Answer: D
Rationale: Hypotension is an adverse effect of bromocriptine mesylate, and the nurse should check with the health care provider before giving the medication. Diarrhea, cough, and deep vein thrombosis are not associated with bromocriptine mesylate use.
The nurse is caring for a patient with multiple sclerosis (MS) who is to begin treatment with glatiramer acetate. Which of the following information should the nurse include in patient teaching?
- A. Recommendation to drink at least 3-4 L of water daily
- B. Need to avoid driving or operating heavy machinery
- C. How to draw up and administer injections of the medication
- D. Use of contraceptive methods other than oral contraceptives
Correct Answer: C
Rationale: Copaxone is administered by self-injection. Oral contraceptives are an appropriate choice for birth control. There is no need to avoid driving or drink large fluid volumes when taking glatiramer.